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Clinical Images

The Widow Maker: One ECG Pattern You Do Not Want to Miss

Aiman Smer, MBBCh, Mohamed Ayan, MD, Alok Saurav, MD

September 1, 2015

A 65-year-old man presented with chest discomfort. He is a smoker and has strong family history of premature coronary artery disease (CAD). Physical examination was remarkable for grade II/VI holosystolic murmur. ECG revealed sinus rhythm with diffuse ST-segment depression and ST-segment elevation in leads aVR and V1 (figure 1). Laboratory tests were significant for positive troponin I at 1.3 ng/ml. Echocardiogram showed severe hypokinesis of the anterior wall with estimated ejection fraction of 30-35% and moderate mitral regurgitation. 

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References:
1. Li D, Li CY, Yong AC, Kilpatrick D. Source of electrocardiographic ST changes in subendocardial ischemia. Circ Res. 1998;82(9):957-970.
2. Gorgels AP, Vos MA, Mulleneers R, de Zwaan C, Bar FW, Wellens HJ. Value of the electrocardiogram in diagnosing the number of severely narrowed coronary arteries in rest angina pectoris. Am J Cardiol. 1993;72(14):999-1003.
3. George A, Arumugham PS, Figueredo VM. aVR - the forgotten lead. Exp Clin Cardiol. 2010;15(2):e36-44.

 



 

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